This is another vital question that I often have to grabble with when treating patients with ODS. It is ultimely a question for the patient to decide on the answer to. The role of clinicians here is to guide them through the process, but to leave the final judgement for this to the patient.

This does not mean that clinicians should not have an opinion on the severity of patients symptoms. It only means the ultimely the patient have to judge this issue.

It is also important to put in perspective the "cost" of treatment, especially surgery. The cost here is not financial, but going through a big operation [even though most are done laparoscopically], with potential for complications.

I always tell patients to avoid making these judgments during a bad week of severe symptoms & to look back at how good, reasonable or poor is their quality of life over the last few months.

Quality of life should not be viewed separately from the severity of symptoms. Clearly some patients may consider their quality of life to be quite good, even though they have severe bowel symptoms which may dominate a couple of hours of their day. These patients should still be offered surgery to improve their severe symptoms.

It is helpful to try to present this graphically for patients as in the following Flash animation [Click to start].